ANTENATAL GLUCOCORTICOIDS: IS THERE CAUSE FOR CONCERN?

Abstract

Antenatal glucocorticoid therapy was pioneered by Liggins & Howie over three decades ago. In a controlled trial of babies delivering before 32 weeks gestation, it was shown that antenatal glucocorticoid treatment reduced the incidence of respiratory distress syndrome (RDS) and significantly lowered neonatal mortality. Synthetic glucocorticoid (sGC) therapy is also associated with reduced risk of neonatal intraventricular haemorrhage, necrotizing entercolitis and hyperbilirubinaemia. The benefit of antenatal glucocorticoid therapy to lung function in the newborn infant has led to routine use in situations of threatened pre-term labour. In 1994, a National Institute of Health Consensus Development Conference recommended antenatal treatment of all women at risk of preterm delivery, between 24 and 34 weeks of gestation, with sGC. Similar statements were issued in Europe, Canada and Australia. However, the NIH Consensus Report highlighted the requirement for further research into the long-term effects of antenatal sGC treatment on development of the brain and other organ systems, and their function after birth.